Surgery for Crohn’s Disease

We know the thought of surgery can feel overwhelming. We hope to alleviate your fears by providing you with information about the reasons why surgery may be necessary and about the different types of surgery that may be recommended.

Crohn’s disease is a lifelong illness. While medication is often the first treatment option, many people with Crohn’s disease eventually require surgery.

Some patients may choose to have surgery to improve their quality of life. For others, surgery is a life-saving necessity due to medical complications of Crohn’s.

Primary goals for Crohn’s disease surgery

Conserve as much bowel as possible

Alleviate disease complications

Help patient achieve the best possible quality of life

Disclaimer: This information should not replace the recommendations and advice of your doctor. Surgery information is up to date at the time of publication. You should always check with your doctor for the most current information.

Crohn’s Disease Surgical Procedures

There are several different types of surgery for Crohn’s disease, depending on the location of the disease in your GI tract and the complications you are suffering.

Crohn’s Disease Complications Requiring Surgery

Medication alone may not adequately control symptoms for everyone with Crohn’s disease. Complications can develop that need more aggressive treatment, including surgery. Seek immediate medical attention if you believe you may have one or more of these complications.

Intestinal obstruction or blockage

Chronic inflammation in the intestines can cause the walls of your digestive organs to thicken or form scar tissue. This can narrow a section of intestine, called a stricture, which may lead to an intestinal blockage. Symptoms of a blockage include crampy abdominal pain, inability to have a bowel movement or pass gas, nausea and vomiting, and constipation.

Excessive bleeding in the intestine

This is a rare complication of Crohn’s disease. Surgery is performed only if the bleeding cannot be controlled with other treatments.

Perforation of the bowel

Chronic inflammation may weaken the wall of the intestine and cause a hole called a perforation. This can also happen if a portion of the bowel expands and weakens near a stricture. Once the intestinal wall has been perforated, the contents of the intestine can spill into the abdomen and cause a serious infection called peritonitis.

Fistula

Inflammation can cause sores, or ulcers, to form in the inside wall of the intestines or other organs. Sometimes, these ulcers can extend through the entire thickness of the bowel wall and form a connection or tunnel, called a fistula. Fistulas often occur between two parts of the intestine, between the intestine and another organ such as the bladder or vagina, or break through to the skin surface.

Fistulas can also form around the anal area, which may cause drainage of mucus or stool from an area adjacent to the anus.

Abscess

An abscess, or a collection of pus, can develop in the abdomen, pelvis, or around the anal area. Symptoms include severe pain in the abdomen, fever, painful bowel movements, discharge of pus from the anus, or a lump at the edge of the anus that is swollen, red, and tender. An abscess requires both antibiotics and surgical drainage of the pus cavity.

Toxic megacolon

Severe inflammation in the colon can lead to toxic megacolon. Symptoms include pain, distention/swelling of the abdomen, fever, rapid heart rate, constipation, and dehydration. This is a potentially life-threatening complication that requires immediate treatment and surgery.

Elective Crohn’s Surgery

Doctors and patients will often consider surgery if a person’s quality of life has been severely impacted despite medical treatment, or if they experience significant side effects from their medication.

Some people find they are no longer responding to their medication. Others decide they are no longer able to cope with severe side effects from their medication.

Colorectal cancer

Patients with Crohn’s disease and ulcerative colitis have a higher risk for colorectal cancer (CRC) than the general population, so elective surgery may be recommended to eliminate that risk.

Colorectal cancer risk factors

The risk of CRC increases after living with IBD for 8 to 10 years

The risk increases the longer a person lives with IBD

The greatest risk is for people with IBD affecting their colon

In most cases, colorectal cancer begins as a polyp, or a small lump growing from the wall of the intestine. Polyps typically start out benign, or not cancerous, but become cancerous over time. In patients with IBD, abnormal and potentially precancerous tissue, called dysplasia, may lay flat against the wall of the intestine and can even be found in areas of the intestinal wall that appear normal during a colonoscopy.

Colorectal Cancer Screening

If you’ve had IBD symptoms for 8 to 10 years or longer, you should have surveillance colonoscopies every one to two years depending on your other risk factors, such as a family history of colorectal cancer.

A standard colonoscopy is usually accompanied by a series of biopsies, which are small tissue samples taken for microscopic examination.

If dysplasia is found, even if it’s not cancerous, surgery to remove the colon and rectum is usually recommended to eliminate the risk of developing cancer.

Choosing Your Healthcare Team

If you have been recommended for surgery, you and your doctor should consult with a colorectal surgeon who specializes in surgery of the gastrointestinal tract. Your regular gastroenterologist will continue to treat you before and after your surgery.

If surgery is elective, take time to research a surgeon and a hospital that fits your needs.

Your surgeon should be board certified in general surgery or colon and rectal surgery, and should have significant experience performing the surgical procedure that has been recommended for you. Ask your surgeon about his or her experience. Do not be afraid to seek a second or third opinion.

Talk with your surgeon and your other healthcare providers about what preparations you may need before surgery, what to expect after surgery, and any medical supplies you might need once you return home.

Check to see if your state health departments publish data about the outcomes of certain procedures at specific hospitals.

Thank you to Bonnie & Andrew Stern for supporting the development of educational images and resources on surgery options. Additional support is provided through the Crohn's & Colitis Foundation's annual giving program and donors.